Study on the changes of pelvic floor structure in different time after hysterectomy by transperineal ultrasound

Abstract

Objective To evaluate the changes of pelvic floor structure and function quantitatively in different periods after taking total hysterectomy by transperineal pelvic ultrasound. Methods A total of 105 female patients who underwent ultrasound examination after hysterectomy at the Second Hospital of Lanzhou University from March 2016 to July 2017 were enrolled. Among them, 37 cases were 40-49 years old, 49 cases were 50-59 years old, 19 cases were over 60 years old; 29 cases were less than 1 years after hysterectomy, 33 cases were>1,≤5 years after hysterectomy, 28 cases were>5,≤10 years after hysterectomy, and 15 cases were over 10 years after hysterectomy. A total of 120 female volunteers from the Second Hospital of Lanzhou University who had not been diagnosed with pelvic floor dysfunction (PFD) were selected as the healthy control group without total hysterectomy or other pelvic floor surgery. All subjects were examined by pelvic floor ultrasound. The distance from the bladder neck to the lower edge of pubic symphysis (X), urethral angle (α), retrovesical angle (β), the distance from the lowest point from the rectal ampulla to the lower edge of pubic symphysis (D) and detrusor thickness under resting state and maximal Valsalva state were measured. And the urethral rotation angle (Rα) and bladder neck descent value (BND) were calculated. T test was used to compare the ultrasonic quantitative parameters between the total hysterectomy group and the healthy control group, and the detection rate of PFD was compared by Chi-square test between the patients of different age groups at different time after hysterectomy. Results The thickness of bladder detrusor in total hysterectomy group was significantly higher than that in healthy control group. The age of patients in the total hysterectomy group was older than that in the healthy control group, and the difference was statistically significant. At rest, compared with the subjects in the healthy control group, the βincreased, the X and D decreased in patients with total hysterectomy. The differences were significant. The α increased after hysterectomy, but the difference was not statistically significant. At maximum Valsalva state, compared with the subjects in the healthy control group, the α, β, Rα and BND all increased in the group of total hysterectomy, and the X and D decreased. The difference was statistically significant. The detection rate of PFD in 105 cases of total hysterectomy group was 60% (63/105), the detection rate of stress incontinence (SUI) was 33.3% (35/105), and the detection rate of pelvic organ prolapse (POP) was 36.2% (38/105). In POP, the detection rate of bladder prolapse, rectal prolapse and intestinal hernia was 18.1% (19/105), 10.5% (11/105) and 6.7% (7/105). SUI was the main occurrence of PFD within 1 year after total hysterectomy, and the detection rate was 48.3% (14/29). 10 years after operation, POP was the predominant occurrence of PFD, and the detection rate was 80.0% (12/15). There was no significant difference in the detection rate of PFD between different age groups after hysterectomy, indicating that the detection rate of PFD at different times after hysterectomy may not be closely related to the age of patients. Conclusion Transperineal pelvic floor ultrasonography can dynamically observe the changes of pelvic floor structure after total hysterectomy, and can evaluate PFD quantitatively after operation. Key words: Ultrasonography; Pelvic floor; Stress incontinence; Pelvic organ prolapse; Hysterectomy